Thursday, March 5, 2009

The Health Care Summit: Or, What Were They Thinking?

The White House health care summit started out inspiringly. Single payer advocates organized their way into the room. The President had originally refused to invite Rep. John Conyers, the lead co-sponsor of the House’s Medicare for All bill, HR 676. The bill would virtually eliminate the private insurance industry, something the President had taken off the table in a nod to that industry’s power and past political clout. But Physicians for a National Health Program and other activists generated massive phone calls in protest, and threatened to demonstrate in front of the proceedings. Rep. Conyers was invited in, along with PNHP President Oliver Fein, MD.

It was a bracing early victory.

Compared with last week’s economic summit, the health care event had the aura of a classroom political science exercise rather than a call to address a pressing financial and humanitarian crisis, with causes and effects, as well as known – if politically difficult - solutions.

Government officials have spent months excoriating the malfeasance of corporate executives and lax regulators who brought the economy to rack and ruin. And then turned around and given them more bucks. The economic summit ended on a forceful note: Fix the health care system, or we doom prospects for economic recovery.

But once at the health care discussion, no actor was excluded from a civil hearing (including, ultimately, single payer). The insurance industry, pharmaceutical manufacturers, hospitals, employers, doctors and nurses, and national leaders of health care consumer groups flanked members of Congress to describe the crises in access, costs and quality. They broke into several groups to talk about the issues for about an hour and a half, then reconvened to chat further with the President.

In the group televised on C-Span, and moderated by Melody Barnes and Bob Kocher, members of Congress provided the most grounded and the most pointed comments in the face of nearly surreal assertions by others on the panel. Business Roundtable Chair Ken Powell, CEO of General Mills, a processed food giant that has lost 30% of its stock value since September and experienced its share of layoffs, waxed eloquent about how employers are firmly committed to continuing to play a central role in providing health benefits to their employees. They love doing it and by golly they feel good about how good they are at doing it! They’re offering wellness programs that make a real difference in their employee’s lives. He didn’t exactly address how we should deal with the 40% of employers who offer no benefits at all (a detail Rep. Rob Andrews of New Jersey pointed out). In other words: they don’t want the government to do it.

Blue Cross Blue Shield likewise marveled at its own wellness programs. Though they did agree it was time for reform. (Probably need to do something about those pesky pre-existing condition exclusions.) As long as everyone is required to pay into the system. Well actually, to pay them. They didn’t really see the need for a competing public insurance plan.

It was up to Rep. Allyson Schwartz to mention that there are no hospitals left in northeast Philadelphia that deliver babies. She also mentioned the newborn baby who had jaundice for the first five days of life and was denied insurance coverage just about straight out of the womb, because of the risk that she might someday develop liver disease. Rep. Baron Hill of Indiana confessed that 60% of his generally conservative constituency thought that the government should take over the health care system, though they were divided about exactly how. A somewhat ambivalent Jan Schakowsky soldiered on in allegiance to an Obama-like hybrid plan, but stuck up for Medicare as a program popular with its beneficiaries, and well run. Republican Jo Ann Emerson spoke movingly about the failures of access in rural areas, and nodded to Sen. Byron Dorgan who continues to team up with her to propose legal reimportation of affordable drugs. (PhRMA CEO Billy Tauzin was in a different breakout group.)

Rep. Earl Pomeroy and Sens. Whitehouse and Hatch bemoaned the perverse incentives and poor outcomes of the delivery system.

But John Dingell took the cake. In a few sentences, he recalled his father introducing the first single payer bill in the U.S. Congress in 1943, though he was beaten to the punch by “those socialists, Edward VII of England and Bismarck in Germany.” He agreed with his colleagues who suggested, in a masterful stroke of understatement, that the current system is too administratively cumbersome and should be simplified.

I have yet to watch the rest of the discussions online, including the one attended by the ever-eloquent Dr. Fein. The group of Congress members I watched clearly reveres the President, and no one’s breaking ranks just yet. And they all knew they were on TV. But are they ready to contract out the job of controlling health care costs to the same cast of characters that dug us into this hole in the first place? One makes predictions about health care politics only at great peril. So for now the best answer is, maybe. And maybe not.